I am 42 yrs old had a myomectomy at when I was 37. I had a miscarriage at 39 and have an enlarged left ovary and bulky uterus with multipel inta-mural fibroids. My right ovary contained about 8 small follicles and my enlarged left ovary contained two separated follicles but there was no adnexal mass. We would love to get pregnant but don't really understand what all this means. Obviously I guess my chances are reduced. Please shed some light. Thanks

Hello XXXXXXX,
Let me try and explain your reports and findings as best as i can.
Fertility is rather a complex issue. As doctors we give out information about what factors will reduce fertility. Understand that such figures are generalizations based on probability. They may not be applicable to A patient - you.

With this as background, lets analyse this together.
Fibroids per se do not decrease fertility. You have intra-mural fibroids = inside the WALL of the uterus. In my practice i have often noticed that ultrasound is not very sensitive to differentiate between fibroids in the wall of the uterus from those inside the cavity of the uterus. A Hysteroscopy examination using a telescope to see inside the uterus can make things very clear. If there are fibroids in the cavity then they can be removed hysteroscopically too. The procedure is awesome and beautiful. You have excessive and heavy periods; the possibility of there being intra-cavitary fibroids is high. Generally we would leave all other kinds of fibroids be. However, there are latest reports to suggest that if ALL OTHER CAUSES OF INABILITY TO CONCEIVE have been ruled out, then the removal of the fibroids may improve fertility.

So the first step would be to find whether there are other factors in your case which decrease fertility -
1. Hypothyroid. Get a check done on Free T4 and TSH and if required have your dose tailored by your doctor.

2. Multiple follicles in ovary. This could be a multifollicular ovary which may not have much effect on fertility. On the other hand it could be a Poly Cystic Ovary Syndrome (PCOS) which is associated with delayed or absent egg release (ovulation). A good ultrasound scan report will be able to tell. If you have PCOS then simple medicines will help release an egg every cycle and timed coitus or artificial insemination may result in pregnancy.

3. Now let me consider your age. Fertlity declines after age 35 years. This is a generalization and may not be true in your case. It would be wise to check out your Ovarian Reserve by some blood tests like Serum FSH and Serum AMH. Discuss this with your doctor. If Ovarian Reserves are already low then it would be prudent to visit a specialized IVF Centre asap rather than hang around, dithering and wasting time. CERTAINLY you can have a baby. Why should you be denied your desire. Go about it intelligenty and in a focussed manner to reach your goal.
My best wishes with you,
Dr Nirja Chawla